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IV PCA for Pediatric Patients

Constance Monitto, M.D.
The Johns Hopkins Hospital, Baltimore, MD

What is IV PCA?

IV PCA stands for Intravenous (in the Vein) Patient Controlled Analgesia. This means that you, the patient, have control of your pain medicine. You will have a special machine called a PCA pump that contains your pain medicine hooked up to your IV, and there will be a button attached to the pump that you can press to give yourself extra doses of pain medicine when you need it.

Who can use PCA?

PCA is used in patients who are having moderate pain, but are not ready to take their pain medicine by mouth. PCA was initially used in adults, but it is now available to children at many hospitals as well. In general, children who are 5 to 6 years of age or older, who are able to press a button, and can understand the idea of using the PCA pump to help control their pain, are able to use a PCA.

How does pain affect the body?

Pain occurs when the body is injured, warning you to avoid more injury. But pain that continues and is not taken care of can be harmful, especially when you are sick or after surgery. Pain can make it hard for you to take deep breaths and may keep you from getting out of bed and walking. Poorly treated pain can cause problems that might make you need to stay in the hospital longer.

How will the doctors and nurses know how much pain you are having?

Your nurses will check on you when you are having pain. They will ask you to rate your pain (give your pain a number) on a 0 to 10 scale. A rating of 0 means you have no pain, 5 means you feel a medium amount of pain, and 10 means you feel the worst pain you can imagine. Your nurse may also use another pain rating scale called the FACES scale, and ask you to point to the face that best shows how much pain you are having. Parents: if your child is unable to rate his/her pain using a number, there are other pain scales that the nurses or doctors can use to help decide how much pain your child is having.

You may have a lot of pain, especially when you move or cough, that is not helped by pushing the PCA button. If so, you can let your doctor or nurse know, so that you can receive more pain medicine.

Why use IV PCA for pain management?

IVPCA is used to try to help keep your pain from becoming very bad or out of control. Because you control when you receive your pain medicine, you can use it when you need it. If you are more comfortable, this will help you heal by allowing you to sleep, take deep breaths, cough, walk, and visit with family and friends.

There are a number of advantages to getting your pain medicine with a PCA pump. Because PCA goes through the IV, it takes away the need to get your pain medicine by a painful "shot". There are also differences in the amount of pain medicine each patient needs to control their pain. PCA allows the patient to help decide how much medicine is enough. In addition, because you control the pump button, you are able to give yourself extra medicine at the time you need it, instead of having to wait for your nurse or doctor to get it and give it to you.

How does IV PCA work?

PCA uses a specially designed pump to allow pain medicine to be given through your IV line. Sometimes a small amount of pain medicine is given all the time by the pump. In addition, you will have a PCA button that is attached to the pump. It looks like a video game button. You can press the button to give yourself some extra pain medicine from the pump when you hurt, or you can use it 5 or 10 minutes before you are getting out of bed or doing something else that you know will hurt.

Because it is harder to fix pain if it gets really bad, when you start to feel pain, push the PCA button. If after a few minutes, the pain is still there, push the button again. Let your nurse or doctor know if the pain medicine is not working.

Is IV PCA safe?

The PCA pump will be set to give you an amount of medicine which is generally safe for someone your size and age, and experiencing your type of medical problem or surgery. If this is too much medicine for you, the amount can be made smaller. If it is not enough, the amount of medicine can be made bigger. To make things as safe as we can, the pump will be programmed to limit the size, number, and frequency of doses of pain medicine you will receive. This should allow you to get enough medicine, but makes it very hard for you to give yourself too much pain medicine. To make things as safe as we can, it is very important that no one push the PCA button except you, the patient.

What medicines are used in the PCA pump?

Medicines called opioids (sometimes called "narcotics") are used to treat pain. The opioid medicines most commonly used are morphine, hydromorphone (dilaudid), or fentanyl. Which medicine is used depends on your size, age, and type of pain or pain problem. These medicines work by stopping the pain message as it travels from the area experiencing the pain to the brain and spinal cord.

What are the side effects of PCA?

There are a number of bothersome side effects that can happen when you are given opioid pain medicines. Itching is a very common side effect of the pain medicine in the PCA pump. In general, this itching is not an allergic reaction. Nausea, with or without vomiting, can occur from pain medicine. Pain medicine also slows the bowel and may cause constipation (hard bowel movements). Many patients receiving PCA are ordered to receive medicines to treat these side effects when and if they occur.

Some children have problems urinating (peeing) while on pain medicines. Usually, reducing the dose of medicine is helpful to treat this side effect.

Sleepiness and slow breathing are the most serious side effects of IV pain medicine, but do not happen often. Most children receiving IVPCA will have their heart and breathing monitored once their pain medicine is started, and their nurse will check them often. If these side effects do occur, the pain medicines can be decreased and if needed, medicine can be given to reverse these serious side effects.

How long will IV PCA be used?

As you get better, your pain will naturally be less over time. You will find that you need to push the PCA button less often than you did at first. When you are able to eat, you will receive pain medicine that you can take by mouth. The amount of oral pain medicine you are taking can be adjusted so that you are more comfortable if this is the case.

What about addiction to the pain medications?

Drug addiction is a very common fear and something that many children are learning about in school. Addiction means that someone is taking the medicines (opioids) for psychological reasons, not for physical pain. Many scientific studies have been done with patients who get medicines like morphine for pain. It is extremely rare for addiction to occur in patients who are taking medicines to treat pain.

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